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RA965  .L96  1 876      Dispensaries :  their 


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T3NSARI      -       LEIR  ORIGIN 


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1b,S 

DISPENSARIES 


THEIR 


Origin,  Progress  and  Efficiency 


BY 


WM.   «.   LTJDLUM,  M.  D. 

MEMBER   OP    THE   N.  Y.  ACADEMY   OF   MEDICINE,  MEMBER  OP  N.    Y.   COUNTY 
MEDICAL   SOCIETY  AND  AMERICAN   OTOLOGICAL   SOCIETY,   ATTENDING 
PHYSICIAN  AT  DEMILT  DISPENSARY,   DEPT.  OP  THE  EYE  AND 
EAR,  AURAL  SURGEON  N.    Y.    EYE  AND  EAR  INFIR- 
MARY, MEMBER  OF   THE  N.  Y.  MEDICAL  JOUR- 
NAL ASSOCIATION,   ETC.,   ETC 


\ 


NEW    YORK: 
G      P.    PUTNAM'S     SONS, 

1S2  FIFTH    AVENUE 


0  <Xaa_0-oo  OulJ 


DISPENSARIES 


ORIGIN,   PROGRESS   AND   EFFICIENCY. 


Read   before   the   New    York   Medical   Journal   Association,   on 
Friday  Evening,  April  2lst,  1876. 

"Me.  President  and  Members  of  the  Association: 

"Your  attention  is  first  invited  to  a  partial  consideration  of 
the  latter  portion  of  my  subject,  viz.,  'The  Efficiency  of  Dis- 
pensaries.' I  shall  begin  with  the  re-publication  of  a  certain 
anonymous  volunteer  contribution  of  my  own,  which  appeared 
in  the  New  York  Daily  Tim.es.  I  was  aroused  to  write  this 
article  on  account  of  the  previous  appearance  in  the  same 
journal  of  an  inflammatory  account  of  the  case  of  an  English 
woman  named  Ann  Tipple,  who  was  brought  before  the 
magistrates  in  the  City  of  London  for  violation  of  the  require- 
ments of  the  Vaccination  Act.  This  article  of  mine  contains 
quotations  from  that  inflammatory  account,  and  gives  certain 
dispensary  statistics  and  personal  experience  connected  with 
vaccination,  in  which  department  of  medical  service  Dis- 
pensaries have  done  peculiarly  effective  work.  And  one 
object  which  I  have  in  view  in  re-publishing  it  on  the  present 
occasion  is  to  correct  certain  typographical  errors  which  were 


overlooked  by  the  proof-reader.     Sere  follows  the  article  in 
question  : 

"  Toth  Editor  of  the  New  York  Times;  k  Is  Vaccination 
Dangerous?  '  This  question  was  propounded  in  the  New 
York  Times  on  Monday,  August  30  (1869),  and  with  it  an 
invitation  for  the  doctors  to  come  forward  with  reasons  for 
their  faith  in  vaccination.  But  the  burden  of  proof  naturally 
lies  with  those  who  doubt  the  efficacy  of  vaccination.  Those 
who  make  the  general  statement  that  vaccination  is  danger- 
ous, might  be  very  properly  called  upon  to  establish  the 
genera]  fact,  and  the  appeal  can  be  made  to  general  experi- 
ence. If  the  general  verdict  of  the  world  is  against  vaccina- 
tion, the  fact  would  be  beyond  the  range  of  either  faith  or 
discussion.  Waiving,  however,  the  right  usually  conceded  to 
the  defence  with  regard  to  the  burden  of  proof,  this  much 
may  be  said  now,  viz.,  that  Ann  Tipple's  experience  amounts 
to  nothing  ;  and  if  it  were  multiplied  fifty-fold,  it  would  make 
but  slight  difference  among  the  almost  infinite  number  of 
cases  where  vaccination  has  not  been  followed  by  deleterious 
results.  Exceptions  to  the  general  rule  do  not  militate 
against  it. 

"Ann  Tipple,  it  appears,  was  so  unfortunate  as  to  lose  one 
of  her  children  three  days  after  it  was  vaccinated,  but  how 
many  children,  in  the  course  of  time,  died  in  consequence  of 
taking  the  small-pox  from  the  other  four  who  were  not  vac- 
cinated ?  and  how  many  other  children  were  exposed  to  danger 
by  such  neglect  ?  If  in  this  woman's  experience  is  summed  up 
the  indictment  against  Jenner's  discovery,  let  us  have  all  the 
facts,  in  order  that  we  may  form  an  intelligent  and  Logical 
conclusion  respecting  this  narrow  aspect  of  the  case,  as  it  is 
given  to  us.  Let  us  grant,  for  the  sake  of  argument,  lei  us 
grant  that  death  was  the  consequence  of  vaccination  in  the  case 
of  one  of  Ann  Tipple's  children.    Even  then  vaccination,  with 


all  its  dangers  (if  it  have  any  danger  in  itself),  would  be  prefer- 
able to  allowing  the  general  mass  of  children  to  incur  the  risks 
they  are  naturally  liable  to  if  not  protected  by  vaccination. 
If  one  child  in  ten  were  actually  lost  in  consequence  of  vac- 
cination, the  general  good  would  be  promoted  in  giving  the 
other  nine  the  benefits  of  vaccination.  Anomalous  cases  are, 
after  all  that  may  be  said,  of  very  little  account. 

"  As  a  general  rule,  vaccination  is  of  great  benefit,  and  the 
fact  is  established  by  the  strongest  testimony  that  man  can 
have,  viz.,  the  testimony  of  his  own  senses.  That  vaccina- 
tion is  beneficial  is  not  a  matter  of  faith  or  belief  now,  but  a 
matter  of  fact.  Repeated  trials,  conducted  through  a  long 
series  of  years,  have  settled  the  question  whether  vaccination 
is  beneficial  in  the  long  run  or  not.  And  how  is  it  beneficial? 
In  two  ways.  First,  it  is  beneficial  as  a  preventive.  Under 
its  protection  the  vaccinated  have  gone  fearlessly  among  pa- 
tients sick  with  small-pox,  and,  as  a  general  rule,  escape  con- 
tagion ;  whereas,  as  a  general  rule,  the  unprotected  thus 
exposed,  become  infected.  This  has  been  tested  time  and 
again  all  over  the  world,  and  the  general  verdict  of  mankind 
is  that  a  reasonable  reliance  may  be  placed  upon  vaccination 
as  a  protection  against  the  virulence  and  dangers  of  small-pox. 

"  '  But,'  you  say,  '  Vaccination  is  not  a  certain  preventive 
in  every  case.'  Granted.  There  are  exceptions  to  most 
rules,  perhaps  to  every  rule,  as  far  as  our  knowledge  extends. 
But  vaccination  is  known  to  be  capable  of  modifying  the 
course  of  the  disease  in  those  persons  who  happen  to  have 
small-pox  subsequently.  According  to  general  experience, 
that  is  a  well-established  fact.  And  this  is  the  second  way  in 
which  vaccination  proves  to  be  beneficial. 

"  Small-pox,  as  a  rule,  is  a  protection  against  itself,  but 
that  rule  is  liable  to  exceptions.  Lf  small-pox  itself  is  no 
absolute  protection  against  recurrence  of  the  disease,  it  is  no 


6 

very  great  wonder  that  vaccination  in  some  individuals,  under 
certain  conditions,  tails  to  protect  them.  But  such  exceptions 
do  not  militate  against  the  general  rule. 

"The  benefits  of  vaccination  consist,  then,  either  in  pre- 
venting the  disease  altogether,  or  in  so  modifying  the  consti- 
tution that  the  disease  runs  a  milder  course.  'But  vaccination, 
in  certain  cases,  has  been  followed  by  unexpected  and  la- 
mentable results.'  Granted.  Untoward  results  sometime* 
follow  the  application  of  vaccine  matter,  even  of  the  purest 
kind.  For  example,  ten  children  are  vaccinated  with  the  very 
same  matter,  ground  up  into  a  paste  of  uniform  consistency 
and  character  throughout;  the  arm  of  one  of  those  ten  chil- 
dren inflames  greatly,  perhaps  ;  gangrenous  erysipelas  sets  in 
and  the  child  dies  ;  but  no  such  result  obtains  in  case  of  the 
other  nine,  vaccinated  with  the  selfsame  matter  and  applied 
by  the  same  vaccinator  with  the  self-same  instrument.  In 
the  nine  the  vaccine  pustule,  undisturbed,  runs  a  natural  and 
easy  course.  Now,  what  is  the  reason  for  this  difference  ?  It 
is  clearly  not  traceable  to  the  matter  employed  in  the  vac- 
cination. The  untoward  result  in  the  one  case  is  simply 
associated  with  the  vaccination  on  account  of  certain  indefinite 
and  perhaps  unknown  contingencies.  Other  circumstances 
must  be  ascertained  and  taken  into  account,  and  these  cir- 
cumstances vary  with  each  particular  case. 

"From  constitutional  and  other  causes,  untoward  results 
occasionally  follow  very  simple  surgical  operations,  but  the 
means  employed  are  good  in  themselves,  and  they  should  be 
employed,  notwithstanding  all  the  risks  ;  for  by  avoiding  such 
operations,  you  do  not  escape  danger,  but  on  the  contrary, 
become  liable  to  greater  dangers.  This  is  especially  the  case 
in  regard  to  vaccination,  as  a  precaution  against  danger.  It 
can  not  prudently  be  neglected.  It  is  as  illogical  as  it  is 
unwise  to  single  out  individual  cases  and  give  them  undue 


importance.     The  proper   mode  of  studying  out  this  question 

is  to  consider  its  bearings  on  communities.  Then  it  will  be 
learned  that  small-pox  is  more  prevalent  and  more  widely 
fatal  among  those  who  systematically  neglect  vaccination  ;  but 
the  disease  is  less  common  and  less  dangerous  among  com- 
munities where  vaccination  is  systematically  encouraged,  and 
especially  when  it  is  enforced  by  regulation  or  law. 

"  Among  sanitary  laws  and  regulations,  those  relating  to 
vaccination  are  among  the  most  salutary  and  least  trouble- 
some of  any  that  have  ever  been  devised.  Those  now  stand- 
ing on  the  statute  books  of  various  European  countries  (1869) 
have  proved  to  be  the  best  bulwark  against  a  loathsome  and 
terrible  scourge. 

"  The  comparatively  low  rate  of  mortality  from  small-pox 
at  present  (1869)  is  owing  to  the  fact  that  the  advantages  to 
be  gained  from  vaccination  have  been  so  extensively  embraced. 

"  If  such  sanitary  regulations  were  persistently  disregarded, 
the  neglect  would  undoubtedly  be  followed  in  a  few  genera- 
tions by  the  appearance  of  small-pox  in  its  old-fashioned 
vigor,  to  decimate  communities  now  comparatively  free  from 
the  ravages  of  the  disease. 

"In  answer,  then,  to  the  question,  'Is  vaccination  danger- 
ous, per  sef  I  for  one  answer,  '  No  ! '  and  appeal  to  facts  in 
support  of  the  answer. 

"  Isolated  facts  furnish  a  very  insecure  and  fallacious 
foundation  for  forming  a  correct  opinion  in  any  matter.  Ex- 
ceptional cases  oftentimes  furnish  the  most  potent  proofs  of 
the  general  rule  which  they  seem  to  invalidate,  when  you 
come  to  examine  them  thoroughly.  The  fullest  account  that 
we  have  received  of  poor  Ann  Tipple's  experience  is  very 
meagre,  to  say  the  least  of  it.  She  had  too  much  interest, 
moreover,  in  making  an  unfavorable  statement,  in  order  to 
avoid  the  penalty  with  which  she  wTas  threatened.     The  testi- 


mony  of  a  prisoner  at  the  bar  is  worth  very  little,  unless  cor- 
roborated.  Bui  Buppose  her  individual  experience  was  truly 
understood  by  herself  as  a  witness,  and  truly  reported  with- 
out exaggeration,  the  personal  experience  of  the  writer  will 
more  than  counterbalance  it. 

"  The  writer  was  vaccinated  in  infancy,  as  he  is  informed, 
and  hears  the  mark  of  it  well  impressed  on  his  left  arm, 
without  any  disadvantage  in  consequence.  With  equal  safety 
lie  was  consciously  vaccinated  twice  subsequently  during 
childhood  and  youth.  As  is  commonly  the  case,  the  vaccina- 
tions subsequent  to  the  first  one  in  infancy  were  attended  with 
less  marked  manifestations  than  those  which  accompanied  the 
first  vaccination. 

"  Subsequently,  during  adult  life,  having  professional  duty 
to  discharge  in  a  hospital  devoted  exclusively  to  small-pox 
patients,  as  a  matter  of  precaution  I  vaccinated  myself  (that 
being  the  fourth  vaccination  in  the  course  of  my  life),  prior  to 
entering  on  daily  duty,  and  spent  many  days  among  the  pa- 
tients under  my  care,  visiting  them  at  least  twice  a  day. 

"If  any  one  was  ever  thoroughly  exposed  to  the  contagion 
of  small-pox,  I  was  ;  and  if  there  be  any  protective  power  in 
vaccination,  my  immunity  from  the  disease  is  manifestly  trace- 
able back  to  the  first  vaccination  ;  for  the  subsequent  trials 
of  the  vaccine  virus  upon  my  person  in  childhood  and  youth 
amounted  to  next  to  nothing,  and  the  vaccination  in  adult  life, 
three  days  prior  to  entering  on  duty  in  the  small-pox  hospital, 
did  not  take  at  all.  From  these  facts  one  of  two  inferences 
naturally  follow,  viz.,  either  that  effectual  vaccination  in  in- 
fancy wrought  such  a  change  in  my  constitution  that  I  had 
lost  all  susceptibility  to  the  contagion  of  small-pox  for  the 
time  being,  or  else  I  was  born  without  any  susceptibility  to 
the  disease. 

"  As  tar  as   my  own  conclusions   extend,  I  am  inclined  to 


9 

believe  that  my  immunity  from  small-pox  for  forty  years  (I 
may  now  add  for  forty-seven  years)  is  clearly  owing  to  the 
fact  that  I  was  well  vaccinated  in  infancy. 

"Relying  on  this  safeguard,  I  would  not  hesitate  in  the 
least  about  approaching  a  small-pox  patient,  as  far  as  I  am 
personally  concerned.  To  claim  any  special  privilege  above 
the  majority  of  my  fellow  men  in  regard  to  innate  immunity 
from  the  disease  seems  to  me  preposterous  and  absurd.  But 
your  readers  may  draw  their  own  conclusions  and  accept 
either  horn  of  the  dilemma.  Thus  much  with  regard  to 
vaccination  in  my  own  person,  with  regard  to  vaccination  in 
others,  I  can  say  that  in  every  case  that  has  come  within  the 
sphere  of  my  observation,  no  such  result  as  Ann  Tipple  says 
that  she  experienced  in  one  of  her  children  occurred  in  a 
single  instance. 

"In  the  year  1865,  when  there  Was  considerable  anxiety 
among  the  community  in  the  city  of  New  York  with  regard 
to  small-pox,  and  mothers  came  in  great  numbers  to  one  of 
the  dispensaries  of  this  city  (viz.,  the  Northern  Dispensary  to 
which  I  was  then  attached)  to  have  their  children  vaccinated, 
some  difference  was  noticeable  among  the  children  after  vacci- 
nation, but  such  difference  had  no  direct  connection  either  with 
the  virus  employed,  or  the  mode  of  its  application.  During 
the  months  of  January,  February  and  March  (in  1865  at  the 
Northern  Dispensary)  8,741  children  were  vaccinated  (by  Dr.  E. 
B.  Warner,  myself,  and  others  who  took  part  in  the  work),  and 
there  was  not  a  fatal  case  among  the  whole  number.  Among 
such  a  large  number  there  was,  of  course,  a  difference  of  mani- 
festations connected  with  the  course  of  the  vaccine  pustule, 
but  this  difference  invariably  arose  out  of  circumstances  con- 
nected with  the  previous  condition,  surroundings,  and  origi- 
nal  constitution  of   the  child  in  whom  the  difference  was 

exhibited. 
2 


10 

"  Even  healthy  children  are  not  all  alike  in  respect  to  irri- 
tability of  temperament,  and  the  course  of  the  vaccine  pus- 
tule will  be  governed  accordingly,  but  once  in  a  great  while 
perhaps  one  child  out  of  a  vast  multitude  might  have  a  highly 
inflamed  arm  subsequent  to  the  insertion  of  the  vaccine  virus, 
and  in  consequence  of  neglect,  or  mismanagement,  mortifica- 
tion and  death  ensue,  as  in  the  case  of  poor  '  Ann  Tipple's 
child.'  But  such  an  extraordinary  case  is  an  anomaly.  The 
occurrrence  of  exceptional  cases  may  be  very  sad  to  contem- 
plate but  their  importance  should  not  be  unduly  magnified. 
(Some  careless  feeders  have  choked  themselves  to  death  in 
eating  roast-beef  even  of  the  very  best  quality.) 

"  The  great  practical  object  to  be  aimed  at  is  to  secure  the 
greatest  amount  of  good  to  the  greatest  number  of  persons 
(in  vaccination  and  other  matters.)  As  a  preventive  measure 
against  the  spread  and  virulence  of  small-pox,  vaccination  is 
practically  the  best  method.  That  is  the  general  verdict  of 
all  who  have  had  anything  like  extensive  acquaintance  with  re- 
gard to  vaccination  and  small-pox.  It  is  a  very  fallacious  line 
of  argument  that  is  based  upon  exceptional  cases. 

"  There  are  contingencies  which  are  beyond  the  science  and 
art  of  men  to  control,  and  such  contingencies  unfortunately 
exist  in  every  department  of  (life  as  well  as  in)  medicine  and 
surgery.  If  such  contingencies  and  the  failures  in  guarding 
against  them  in  medical  art  and  surgical  practice  are  to  be 
unduly  magnified,  we  might  as  well  abandon  all  remedial  mea- 
sures, for  the  best  remedial  measures  have  never  yet  been  inva- 
riably successful  (in  all  cases.)  As  science  advances  we  may, 
perhaps,  be  able  at  a  later  day  to  confine  the  dangers  arising 
out  of  obscure  contingencies  within  (still)  narrower  limits 
(than  at  present.)  As  far  as  small-pox  is  concerned,  the  path 
of  safety  lies  not  in  discouraging  but  in  encouraging  universal 
dependence  in  vaccination  as  practically  the  best  known  pre- 


11 

ventive  and  modifier  of  such  a  terrible  disease  (arid  the  mana- 
gers of  the  public  prints  will  be  doing  good  service  if  they 
avoid  publishing  accounts  of  extraordinary  cases,  as  sensa- 
tional matter,  even  if  true.) 

"According  to  the  bills  of  mortality  in  the  City  of  London 
from  1700  to  1800,  before  the  introduction  of  vaccination,  the 
average  annual  mortality  from  small-pox  was  1,780,  in  a  pop- 
ulation of  261,233,  that  is,  one  in  147.  From  1800  to  1855, 
after  the  introduction  of  vaccination,  the  average  annual  num- 
ber of  deaths  (from  small-pox)  was  reduced  (by  vaccination) 
to  821,  with  a  population  of  2,250,000,  that  is,  one  in  2,740. 

"According  to  the  record  kept  at  the  Royal  Military 
Asylum,  it  appears  that  out  of  every  thousand  boys  admitted, 
who  had  been  vaccinated  effectually,  only  7  too  were  subse- 
quently attacked  by  small-pox,  and  not  one  fatal  case  oc- 
curred among  those  affected  with  modified  variola. 

"  From  the  records  kept  at  the  London  Small-pox  Hospital, 
where  patients  of  all  ages  are  to  be  found,  the  mortality  among 
those  who  had  been  effectually  vaccinated  was  less  than  1^ 
per  cent.,  while  the  mortality  among  those  who  had  not  been 
vaccinated  averaged  27^  per  cent.  The  facts  with  regard  to 
vaccination  and  small-pox  have  been  thoroughly  studied  out 
in  England,  and  the  statistics  of  that  country  can  be 
relied  on. 

"The  Act  of  Parliament  which  Ann  Tipple  violated,  was 
passed  in  1853,  and  under  its  provisions  parents  and  guardians 
are  obliged  to  have  every  infant  vaccinated  within  four  months 
from  birth,  unless  the  state  of  the  child's  health  renders  it 
necessary  to  postpone  the  operation.  It  is  one  of  the  best 
legislative  acts  ever  passed.  It  is  not  based  on  theory  or  faith 
in  a  result  to  be  expected,  but  it  is  the  fruit  of  practical 
observation,  extending  as  far  back  as  the  year  1795.  For 
more  than  half  a  century  evidence  has  been  accumulating  that 


12 

vaccination,  as  a  general  rule,  is  of  great  practical  benefit. 
There  are,  and  there  perchance  always  will  be,  occasional 
exceptions  to  the  uniformity  of  the  results.  But,  sum  up  all 
the  unfortunate  cases  to  be  discovered  and  credit  them  to  the 
various  accounts  to  which  they  properly  belong,  as  for  example, 
'gross  carelessness,'  'unskilfulness,'  'mismanagement,'  or 
'  unavoidable  contingencies,'  and  still  the  maxim  holds  good 
that  it  is  better  for  the  community  at  large  to  rely  on  vaccin- 
ation than  to  do  without  it."  *  *  *  * 
— JV%  Y.  Daily  Times,  Sep.  5.  1869. 

So  much  for  this  article,  as  revised,  corrected,  and  slightly 
amplified  by  the  author.  I  have  introduced  it  here  in  order 
not  to  break  the  continuity  of  thought  in  other  matter,  by 
another  hand,  relating  to  the  same  subject,  which  I  will 
reach  subsequently. 

At  this  point  I  may  now,  however,  introduce  one  of  the 
most  recent  opinions  delivered  by  an  English  authority  in 
respect  to  the  efficiency  of  methods  employed  for  preventing 
the  spread  of  small-pox.  In  this  country  we  have  largely  con- 
tributed to  that  end  by  means  of  dispensaries.  From  the 
opinion  expressed  by  Wm.  Squire,  M.  D.,  M.  R.  C.  P.,  Phy- 
sician to  St.  George's  Dispensary,  Hon.  Secretary  'of  the 
Epidemiological  Society,  &c,  &c,  in  a  paper  entitled  "On 
Sanitary  precautions  against  the  Infectious  Eruptive  Diseases," 
read  before  the  last  meeting  of  the  "National  Association  for 
the  Promotion  of  Social  Science,"  in  the  Public  Health  Section, 
as  reported  in  the  "London  Practitioner'1''  for  February,  1876, 
pp.  163  and  164,  we  may  learn  what  dangers  appear 
to  threaten  the  English  people  from  remissness  in  this 
direction.  Mr.  Squire  says,  among  other  things,  "  Until  quite 
of  late  we  have  retrograded  in  the  matter  of  providing  against 
infectious  eruptive  diseases,  and  the  old  buildings,  once  com- 


13 

monly  known  in  England  as  the  'pest  houses,'  have  disappeared, 
without  being  replaced.  *  *  * 

Vaccination  so  far  suppressed  small-pox  that  those  refuges 
became  vacant;  less  accommodation  of  this  kind  is  now 
needed,  or  more  rarely  required,  but  it  is  not  safe  or  right  to 
do  away  with  this  prime  necessity  in  dealing  with  infectious 
diseases;  unless  the  first  unit  of  disease  be  controlled,  we 
cannot  be  sure  how  far  it  will  extend ;  circumstances  might  at 
any  time  arise  which  would  make  it  spread ;  cold,  want,  war, 
famine,  or  even  the  temporary  predominance  of  the  social 
errors,  which  find  expression  in  anti-sanitarian  societies,  might 
admit  pestilence.  What  this  last  element  may  do  in  again 
disclosing  to  us  the  ravages  of  small-pox  I  will  illustrate  by 
some  facts  from  that  greatest  of  modern  medical  observers, 
Wunderlich  of  Leipzig.  In  1868,  he  tells  us  that  the  number 
of  children  vaccinated  in  Leipzig — a  town  then  of  106,000 
inhabitants — was  3,443 ;  in  1869,  the  number  vaccinated  was 
1,970,  and  in  1870  it  had  fallen  to  1,340. 

"  An ti- vaccination  leagues,  clubs,  and  papers,  had  so  pre- 
vailed, that  one  half  of  the  children  born  at  this  time  were 
unvaccinated.  One  reason  of  this  was,  that  for  twenty  years 
small-pox  was  almost  unknown  in  Leipzig.  But  now  came 
the  war  with  France  ;  prisoners  were  received  in  Leipzig,  and 
with  the  French  prisoners  came  in  small-pox ;  in  little  more 
than  a  year  from  the  end  of  1S70,  one  thousand  and  twenty 
persons  died  of  small  pox  in  Leipzig,  or  one  per  cent,  of  the 
entire  population ;  of  the  deaths  312  were  adults,  and  715 
children,  instead  of  the  number  of  deaths  being  greater  in 
those  over  15  years  of  age  as  in  protected  communities. 
Imagine  such  a  state  of  things  to  be  arrived  at  in  London,  and 
thirty  thousand  children  would  be  swept  off  in  one  year, 
*  *  *  by  a  form  of  death  from  which  the  adults,  who 
allow  it  are  exempted  by  the  very  means  of  safety  which  they 


14 

deny  to  these  helpless  victims."  I  pass  now  to  the  iirst  topic 
of  mv  paper,  viz.,  the  Origin  of  Dispensaries,  and  in  regard  to 
this  matter  I  shall  borrow  liberally  from  another,  and  give  his 
own  words  entirely. 

Among  other  remarks  made  at  the  36th  annual  meeting  of 
the  subscribers  of  the  Northern  Dispensary,  held  at  the  In- 
stitution January  9th,  1863,  Judge  Charles  P.  Daly  spoke  as 
follows :  * 

"  In  contrast  with  hospitals,  dispensaries  are  of  compara- 
tively recent  establishment ;  and  it  is  curious  that  so  little  has 
been  collected  in  relation  to  their  origin  and  history.  We 
would  naturally  suppose  that  an  institution  so  useful  and  so 
widely  disseminated  would,  ere  this,  have  found  a  chronicler ; 
that  it  would  be  necessary  only  to  look  into  the  encyclopaedias, 
those  books  of  universal  reference,  to  find  a  condensed  ac- 
count of  all  that  was  known  respecting  them;  but  it  may 
surprise  my  hearers  to  learn  that  these  works  are  almost 
barren  of  information  upon  the  subject,  and  the  remark  applies 
not  only  to  those  in  our  own  language,  but  to  the  more 
elaborate  works  of  this  kind  in  France  and  Germany.  Even 
in  the  very  last  of  these  productions,  the  American  Cyclo- 
paedia, from  which,  having  the  advantage  of  all  that  preceded 
it,  we  should  expect  to  find  a  greater  variety  of  subjects  em- 
braced ;  the  word  Dispensary  does  not  even  occur.  As  I 
happen  to  have  gathered,  in  discursive  reading,  some  informa- 
tion upon  this  subject  which  is  not  very  easily  obtained,  as  it 
is  scattered  over  many  works  differing  widely  in  character 
from  each  other,  it  may  prove  interesting  on  an  occasion  like 
this  to  communicate  it. 

"It  appears  strange  to  us  that  among  nations  so  refined 
and  cultivated  as  the  Eomans   and  the  Greeks,  no  hospital  or 

•  36th  Annual  Report  of  the  Board  of  Trustees  of  the  Northern  Dispensary,  1802.— N.  Y., 
1863,  p.  7,  et  seq. 


15 

institution,  where  the  sick  could  be  taken  charge  of  and  cured, 
was  established. 

"The  first  hospital,  at  least,  of  which  we  have  any  knowl- 
edge, was  founded  by  a  benevolent  bishop,  named  Nonus,  at 
Edessa,  in  Mesopotamia,  A.  D.  460,  a  place  then  famous  for 
its  school  of  theology ;  and  the  first  institution  of  the  kind 
in  Europe  was  built  in  the  same  century,  at  Eome,  by 
Fabiola,  a  Eoman  lady,  a  friend  of  St,  Jerome.  Tn  the  sense, 
however,  in  which  we  understand  it,  an  institution  devoted 
exclusively  to  the  reception  and  care  of  the  sick,  the  hospital 
cannot  be  said  to  have  existed  until  the  eleventh  century,  as 
the  establishments  in  use  before  that  time  were  not  designed 
alone  for  the  sick,  but  also  for  the  reception  and  refreshment 
of  travelers  and  pilgrims. 

"By  the  statutes  of  nearly  every  monastery,  the  tenth  of 
its  proceeds  or  revenues  was  devoted  to  the  poor ;  and  to 
carry  out  this  charitable  design,  a  stone  building  was  erected, 
generally-  close  to  the  church,  called  the  '  Almonry  J  from 
which  we  get  our  modern  word  '  Almshouse.'1  In  connection 
with  the  building  was  a  very  active  officer  called  the  '  almoner  J 
who  had  the  management  of  this  establishment,  and  who, 
among  many  other  benevolent  duties,  was  required  to  find  out 
the  sick  and  infirm  poor,  and  to  administer  to  their  wants  and 
necessities. 

"There  was  also  attached  to  every  monastery  a  large 
garden,  devoted  to  the  rearing  of  esculent  plants  and  medical 
herbs.  *  *  *  *  There  was  also  au  officer  called  an 
'  infirmarerf  whose  especial  duty  it  was  to  take  charge  of 
everything  designed  for  the  sick,  and  in  some  of  the  monasteries 
an  apothecary  shop  was  kept,  which  was  under  his  direction. 
To  the  almonry  the  sick-poor  flocked  from  all  quarters,  and 
when  it  was  necessary,  the  almoner  visited  them  at  their  place 
of  abode.     This  officer  necessarily  prosessed  some  little  knowl- 


n; 

edge  of  medicine,  especially  of  the  healing  properties  of 
plants,  but  it  was  very  limited.  The  art.  of  medicine  had 
their  made  but  little  progress;  bleeding  was  the  remedy 
almost  universally  resorted  to,  with  the  application  of  plants 
to  the  healing  of  wounds,  and  probably  the  most  effective 
service  which  the  almoner  rendered,  was  in  supplying  what  is 
so  necessary  in  sickness,  nourishing  food  and  drink.  In  that 
age,  however,  he  was  of  inestimable  value  to  the  poor, 
uniting,  as  he  generally  did,  the  many  offices  of  alms-giver, 
physician,  apothecary,  religious  consoler  and  friend. 

"As  the  knowledge  of  medicine  advanced,  physicians,  pur- 
suing the  art  as  a  calling,  began  to  practice  in  the  cities ;  and 
in  Zurich  and  in  many  of  the  German  cities  there  was  what 
was  called  the  dadt-arzt,  or  city  physician,  usually  a  man  of 
eminence,  on  whom  the  duty  was  especially  imposed  of  pre- 
scribing for  and  attending  upon  the  poor  of  the  city,  he 
receiving  from  the  city  annually,  in  honorable  recognition  of 
his  services,  certain  household  benefits,  such  as  his  yearly 
firewood,  a  pipe  of  wine,  or  something  of  that  kind,  in  addi- 
tion to  which  he  was  repaid  for  the  medicines  which  he  sup- 
plied to  the  poor. 

"After  the  dissolution  of  monasteries,  the  duty  of  visiting 
the  sick  poor  at  their  abodes,  and  supplying  them  with  gratui- 
tous medical  aid  and  assistance,  was  very  much  neglected. 
*  A  want  was  felt,  and  this  led  to  the  origin  of 
the  modern  dispensary,  the  first  step  towards  which  occurred 
in  the  middle  of  the  sixteenth  century,  and  for  which  the 
world  is  indebted  to  a  woman.  Sattler  tells  us,  in  his 
'  History  of  Wiirtemberg,'  that  in  A.  D.  1559,  a  noble-minded 
and  benevolent  woman,  the  wife  of  Duke  Christopher,  then 
the  reigning  Duke  of  what  is  now  the  kingdom  of  Wiirtemberg, 
caused  an  apothecary's  shop  to  be  erected  in  the  ducal  palace 
at  Stutgardt,  for  the  purpose  of  supplying  medicines  to  the 


17 

poor,  which  she  maintained  at  her  own  expense.  In  1560 
her  example  was  followed  by  the  wife  of  Philip  I.].,  of  Gruben- 
haugen,  a  princess  of  Brunswick,  who  supported,  at  her  court, 
an  apothecary's  shop  and  still-room  for  the  benefit  of  the  poor  ; 
and  it  would,  perhaps,  be  interesting  to  quote  the  language 
of  the  old  writer  by  whom  the  fact  is  recorded.  It  is  from 
Lettzner's  Chronicle,  1596.  'By  her  apothecary's  shop  and 
still-room,'  he  says,  '  we  may  discern  what  real  compassion 
this  Christian-like  Electress  showed  towards  the  poor  who 
were  sick  and  infirm;  for,  by  having  medicines  prepared,  and 
by  causing  all  kinds  of  waters  to  be  distilled,  she  did  not 
mean  to  assist  only  her  own  people  and  those  belonging  to 
her  own  court,  but  the  poor  in  general,  whether  natives  or 
foreigners,  and  not  for  the  sake  of  advantage  or  gain,  but  gratis, 
and  for  the  love  of  God,' 

"Professor  Spittler,  in  his  'History  of  Hanover,' informs 
us  that  in  1568  the  wife  of  the  reigning  Duke  of  Brunswick 
kept,  for  the  use  of  the  poor,  an  expensive  apothecary's  shop 
in  her  palace  ;  and  Beckman,  by  whom  this  information  is 
collected,  mentions  another  instance,  that  of  the  Electress 
Ann,  a  Danish  princess,  who,  in  1581,  established  an  apothe- 
cary's shop  at  the  Court  of  Dresden,  which,  in  1609,  was  re- 
newed by  another  woman,  Hedwig,  the  widow  of  the  Elector 
Christian  II.,  and  which,  I  believe,  is  still  in  existence. 

"  We  are  thus  indebted  not  only  to  a  woman  for  the  estab- 
lishment of  the  first  hospital  that  wras  founded  in  Europe, 
but  we  owe  to  five  women  the  first  attempts  to  meet  a  want 
which  the  modern  dispensary  supplies.  In  Germany,  the 
dispensary,  as  a  distinct  and  separate  institution,  does  not 
exist;  its  place  being  supplied  by  the  admirable  hospital 
arrangement  which  prevails  there.  ******  The 
dispensary  and  the  hospital  are  wisely  combined  under  one 
general  system  of  management  (in  that  country.) 


18 

"The  dispensary  as  a  separah  institution,  had  its  rise  in 
England;  and,  as  the  history  of  its  origin  is  curious  I  will 
narrate  it.  Before  the  close  of  the  17th  century,  the  apothe- 
caries of  London  had  very  generally  adopted  the  habit  of 
giving  medical  advice  gratis,  charging  only  for  the  medicines. 
The  incorporated  physicians  denounced  the  practice  as  a  device 
resorted  to  by  men  wholly  uneducated  in  the  healing  art,  solely 
from  an  interested  motive,  that  they  might  increase  thereby 
the  sale  of  their  medicines ;  while  the  apothecaries,  on  their 
part,  declared  that  the  miserable  state  of  the  sick  poor,  and  the 
inability  of  that  class  to  employ  a  regular  doctor,  rendered  the 
giving  of  gratuitous  medical  advice,  in  connection  with  the  sale 
of  medicine,  an  act  of  necessity  and  charity.  To  remove  this 
ground  of  complaint,  the  College  of  Physicians  and  Surgeons, 
in  1687,  resolved  by  public  act,  that  all  its  members  should 
attend  the  neighboring  poor  without  charge  ;  and  the  apothe- 
caries, who  saw  in  this  movement  a  serious  diminution  of  their 
profits,  managed  to  frustrate  it,  chiefly  by  fomenting  dissen- 
sion in  the  college,  and,  being  an  active  body  cemented 
together  by  mutual  interest,  they  succeeded  in  arraying  in 
their  behalf  a  considerable  amount  of  public  support,  and  in 
keeping  up  a  controversy  which  extended  over  a  space  of 
16  years. 

"  Failing  in  their  first  effort,  the  doctors  resorted  to  another 
measure.  They  turned  the  laboratory  of  their  college,  in 
Warwick  Lane,  into  an  apartment  for  the  making  up  of  medi- 
cines, which  they  disposed  of,  in  a  room  adjoining,  to  all  who 
applied  at  first  cost.  To  the  apartment  they  gave  the  name 
of  the  Dispensary,  a  term  formed  from  two  Latin  words,  dis 
and pendere,  meaning  to  take  from  a  weight  or  mass  and  dis- 
tribute ;  and  which  was  derived  from  a  well-known  word  in 
use  in  the  middle  ages,  dispe?isatorium,  afterward  corrupted 
into  'dispensatory,'  signifying  in  the  early  hospitals,  the  place 


19 

where  the  substances  used  in  the  preparation  of  medicine  were 
kept,  and  from  which  they  were  distributed,  and  which  term 
was   also   used   as   the  title    or  distinguishing    name   of  the 
first  books  which  were  published  upon  the  natural  history  of 
the  substances  which  enter  into  the  composition  of  medicine. 
All  the  efforts  of  the  apothecaries  were  now  directed  toward 
the  breaking  down  this   establishment  of  the  doctors  at  their 
college  in  Warwick  Lane,  against  which  it  struggled  for  some 
time  with  indifferent  success.     A  paper  war  of  unusual  anima- 
tion followed,  a  flood  of  pamphlets  appeared,    and  the  poets 
mingled  in  the  strife.      Sir  Samuel  Garth,  an  eminent  physi- 
cian, published  a  mock-heroic  poem  in  six  cantos,  called  '  The 
Dispensary,'  which  has  taken  its  place  in  our  literature,   in 
which  the  leading  apothecaries  were  most  unmercifully  ridi- 
culed, and  which  had  great  popularity  in  its  time.     Dryden 
came  to  the  support  of  his  fellow-poet,  in  some  stinging  satir- 
ical lines  against  the  vendors  of  drugs,  a  couplet  of  which  I 
remember  : 

' '  From  random  files  a  recipe  they  take, 

And  many  deaths  with  one  prescription  make." 

"And  Pope  espoused  the  cause  of  the  doctors  with  some  of 
his  most  trenchant  verse.  As  the  controversy  progressed,  the 
doctors  gathered  strength.  In  1694,  the  college,  by  a  positive 
edict,  enjoined  upon  all  its  members  the  duty  of  attending  the 
sick-poor  gratis,  and  to  maintain  the  Dispensary,  fifty-three 
physicians,  in  1696,  entered  into  a  liberal  subscription  of  ten 
pounds  each,  after  which  measures  the  establishment  became 
a  complete  success,  as  the  poor  very  naturally  resorted  to  a 
place  where  they  could  get  their  medicine  at  one-third  less 
than  the  apothecaries  charged,  and  where  they  had,  in  addi- 
tion, the  benefit  of  the  very  best  medical  advice  gratis.  The 
apothecaries  now  resolved  upon  a  bolder  course,  that  of 
visiting  patients   at  their  own  houses,    and   prescribing  for 


20 

them  gratuitously.  This,  in  the  judgment  of  the  physicians, 
was  practising  physic,  and  they  waited  but  for  a  convenient 
opportunity  to  bring  down  upon  their  adversaries  all  the 
vengeance  of  the  law.  It  soon  occurred.  A  butcher  named 
Scale  tell  sick  oi  a.  distemper,  and  sent  for  a  neighboring 
apothecary,  called  Rose.  The  latter  went  to  the  butcher's 
house,  ascertained  the  nature  of  the  disease,  and  prescribed 
for  the  patient,  charging  only  for  the  medicines.  The  college 
immediately  brought  an  action  against  the  apothecary,  in  the 
Court  of  King's  bench,  for  practising  physic  without  a  license. 
The  prosecution  of  this  action  became  a  matter  of  great  public 
interest,  and  the  point  involved  was  considered  so  doubtful, 
that  the  case  was  argued  three  times — a  very  unusual  circum- 
stance. Finally,  the  court  decided  unanimously,  that  practi- 
sing physic  was  judging  of  the  nature  of  the  disease,  and  pre- 
scribing the  proper  remedy,  which  they  held  to  be  a  physi- 
cian's vocation ;  and  that  the  business  of  an  apothecary  was 
to  make  and  prepare  prescriptions  under  the  direction  of  a 
doctor.  They  accordingly  gave  judgment  against  Rose.  An 
appeal,  however,  was  taken  to  the  House  of  Lords,  and,  by 
what  has  been  regarded  as  a  very  questionable  decision,  the 
judgment  of  the  Court  of  King's  bench  was  reversed,  to  the 
great  joy  of  the  apothecaries.  It  is  to  this  controversy  that 
we  owe  the  successful  establishment  of  the  Dispensary,  for 
although  the  Royal  General  Dispensary  of  London,  now  the 
oiliest  existing  institution  that  distributes  medicine  gratui- 
tously, was  not  established  until  1770,*  it  had  its  origin  in  the 
circumstances  which  I  have  narrated.  *  *  *  * 
[So  much  for  the  establishment  of  the  Dispensary  in  England.]! 
"The  Dispensary,  as  a  permanent  institution,  was  not  es- 
tablished  in   France  until   1803.      About  the  middle   of  the 

•  Daly,  in  30th  Annual  Report  Northern  Dispensary,  in  1802 N.  Y.,  1863,  p.  12. 

t  Ludium. 


21 

previous  century,  however,  Chamouset,  the  son  of  a  distin- 
guished judge,  and  who  was  himself  advocated  for  the  magis- 
tracy, having  his  attention  drawn  to  the  wretched  state  of  the 
sick  poor  in  Paris,  from  the  want  of  medical  attendance, 
studied  medicine  and  devoted  the  remainder  of  his  life,  with 
the  most  untiring  zeal  and  assiduity,  to  practising  gratuitously 
as  a  physician  among  the  poor.  He  not  only  did  this,  but 
devoted  the  whole  of  his  fortune  to  the  same  noble  object. 
He  turned  his  house  into  a  hospital  for  the  reception  of  poor 
patients,  whom  he  maintained  at  his  own  charge,  and  from 
which  medicines  and  medical  advice  were  furnished  upon 
application,  gratis ;  and  at  all  hours  of  the  day  or  night  he 
was  ready,  at  any  summons,  to  visit  the  bed-side  of  the  sick 
and  wretched.  This  remarkable  man  was  not  simply  a  mere 
benevolent  enthusiast,  he  was  a  man  of  great  good  sense,  of 
acute  observation,  thoroughly  acquainted  with  human  nature, 
and  of  a  practical  and  original  turn  of  mind. 

"He  was  the  originator  of  the  penny-post  and  of  insurance 
against  fires  in  cities  ;  and,  among  other  valuable  suggestions, 
he  devised  and  published  a  plan  for  the  organization  of  an  ex- 
tensive association  in  Paris  among  the  poor  and  working 
classes,  by  which  every  man,  by  the  payment  of  a  small  sum 
of  money,  at  fixed  periods,  might  insure  his  being  well  taken 
care  of,  with  the  best  medical  treatment,  in  case  of  sickness. 
The  suggestion  was  not  lost,  though  nothing  came  of  it  until 
1803,  when  the  Philanthropic  Society  of  Paris  established  five 
dispensaries  for  the  relief  of  the  sick  poor.  The  beneficial 
effect  became  at  once  apparent,  and  similar  institutions  were 
almost  immediately  established  in  I/yons,  Besancan,  Nantes, 
Caen,  Montpelier  and  Marseilles."* 

Now  I  turn  to  General  Mather's  account  of  dispensaries,  as 
given  in  the  last  annual  report  of  the  Demilt  Dispensary  in 

*Daly,  lb.  p.  13. 


22 

the  City  of  New  York,  for  the  year  ending  December  81st, 
1875. 

Frederick  E.  Mather,  Esq.,  the  President  of  that  Institution, 
lias  given  a  very  elaborate  account  of  dispensaries  existing 
among  those  who  speak  the  English  language  and  its  associate 
dialects.  This  account  I  will  condense.  He  speaks  first  of 
the  "Royal  General  Dispensary"  above  mentioned  hy  Judge 
Daly,  as  the  first  institution  of  the  kind  in  England.* 

Then  he  passes  to  the  results  of  the  establishment  of  that 
dispensary,  and  says,  "  that  within  the  next  twenty  years, 
nine  other  dispensaries  were  organized  in  London,"  and  they 
all  are  still  in  existence.  Then  General  Mather  passes  to 
dispensaries  in  Ireland.  In  that  part  of  the  British  dominions 
an  act  was  passed  by  Parliament  as  early  as  1805,  providing 
for  the  establishment  of  dispensaries  throughout  all  Ireland, 
as  well  for  the  most  sparsely  settled  parts  as  for  the  cities  and 
populous  towns.  It  was  a  defective  plan,  but  in  1836  there 
were  494  dispensaries  organized  and  in  operation  under  it. 
The  defects  of  this  plan  of  dispensary  service  were  particularly 
prominent  in  1846  when  famine,  pestilence  and  death  ravaged 
Ireland.  But  in  1851  Parliament  made  a  radical  change  for 
the  better,  and  the  result  was  shown  in  this  wise,  viz.  :  that 
instead  of  there  being  58,006  deaths  from  small-pox  as  from 
1841  to  1851,  there  were  only  12,727  deaths  by  the  same 
disease  from  1851  to  1861. 

In  the  year  1863  vaccination  was  made  compulsory,  and  as 
a  consequence  there  were  only  187  deaths  from  small-pox  in 
Ireland  in  that  year,  and  in  1867  there  were  only  20  deaths 
from  the  same  cause,  and  in  1868  only  23. 

At  this  date  (1868)  the  sanitary  provisions  and  the  medical 
arrangements  for  the  sick  poor  in  England,  Wales  and  Scot- 
land  were  substantially  the  same,  but  a   general  dispensary 

*  25th  Ann.  Rep.  Demi  It  Die  p.  p.  8. 


23 

system  had  not  been  established.  By  the  act  of  1851  the 
general  dispensary  system  was  established,  and  by  the  act  of 
1872  provision  was  made  for  rendering  the  dispensary  districts 
symmetrical  and  compact.  But  there  is  room,  in  General 
Mather's  judgment,  yet  for  improvement  across  the  water  in 
regard  to  dispensaries,  and  he  expresses  the  opinion  that  we  in 
this  country  have  improved  upon  the  lessons  taught  us  from 
1770  downwards.  It  appears  that  the  city  of  Philadelphia 
has  the  honor  of  being  the  first  to  establish  a  dispensary  on 
this  continent,  viz.  :  "  The  Philadelphia  Dispensary,"  which 
was  established  in  April,  1786,  and  incorporated  in  the  year 
1796.  The  city  of  New  York  followed  next  in  order  by 
establishing  "  The  New  York  Dispensary,"  in  1791,  and  it 
was  incorporated  in  1795.  This  dispensary  was  suggested  by 
the  Rev.  Dr.  John  Rodgers.  It  first  occupied  an  humble 
building  on  the  northwesterly  corner  of  Beekman  and  Nassau 
streets,  i.  e.  to  say  it  was  in  the  southeasterly  corner  of  the 
"  Brick  Churchyard,"  but  finally  it  was  located  on  the  north- 
westerly corner  of  White  and  Centre  streets,  where  it  now 
stands. 

The  next  dispensary  was  "the  Boston  Dispensary,"  organ- 
ized in  the  city  of  Boston  in  1796,  and  incorporated  in  1801. 
This  made  the  third  dispensary  in  America.  In  course  of 
time  other  dispensaries  came  into  being,  and  there  were, 
according  to  State  Board  of  Charities'  Report  in  1874,  in  the 
State  of  New  York,  49  dispensaries,  and  29  of  these  are  in  the 
city  of  New  York,  and  they  are  very  good  samples  of  dis- 
pensaries to  say  the  least,  but  General  Mather  says  that  our 
dispensaries  are  better  than  those  across  the  water,  and  I  for 
one  am  very  willing  to  believe  that.  But  I  will  not  waste  time 
in  glorifying  our  nation,  and  will  pass  at  once  to  the  last  topic 
of  my  paper,  viz. :  the  efficiency  of  dispensaries.  According 
to  one  authority,  "  a  dispensary  is  a  place   where  you   get 


24 

medicine  in  your  own  bottles,1'  But  the  late  Charles  Dickens, 
Esq.,  was  always  inclined  to  be  jocular  in  his  descriptions  and 
definitions.  Still  he  spoke  the  exact  truth.  This  same  truth, 
however,  is  very  tersely  and  with  all  gravity  set  forth  in  the 
words  of  Theodore  Roosevelt,  Esq.,*  our  own  countn  man,  as 
follows:  "  Dispensaries  may  be  called  preventive  institutions, 
offering,  as  they  do,  free  relief  to  the  sick  at  the  inception  of 
disease,  an  item  which  is  very  important  in  the  successful 
issue  of  many  diseases;  hence  the  poor  need  not  delay  on  ac- 
count of  expense  or  poverty,  for  at  the  furthest  in  this  city — 
New  York — they  have  but  a  comparatively  short  distance  to 
go  to  embrace  the  proffered  benefit  of  an  institution  incorpo- 
rated and  maintained  expressly  for  them." 

"  From  careful  observation  of  the  workings  of  the  system, 
it  is  but  proper  to  state  that  patients  are  better  treated  and 
obtain  more  real  benefit  from  it  than  any  other '."f 

"  Through  the  efficient  aid  rendered  by  the  officials  many 
useful  citizens  are  saved  from  protracted  sickness  and  fre- 
quently from  death,  while  their  dependents  and  families  are 
kept  from  becoming  applicants  for  private  or  public  charity. 
Family  ties  are  not  weakened  or  broken  by  the  absence  of  a 
member  in  hospital ;  only  those  who  cannot  be  properly 
treated  at  their  houses  need  go  into  an  hospital.  The  value 
of  such  service  in  promoting  public  health,  and  removing  or 
preventing  the  necessity  for  protracted  charity  cannot  be  over- 
estimated."i     *         *         *  * 

"The  medical  and  surgical  staff  (he  goes  on  to  say),  are 
selected  usually  from  a  large  number  of  applicants  from  the 
ranks  of  the  younger  members  of  the  profession,  and  those 
who  are  appointed  are  of  a  high  grade  as  to  attainments,   per- 

•  Extract  from  9th  Add.  Rep.  of  State  Boaid  ot  Charities  of  the  State  oi  X.  Y.,  relatiDg 
to  the  present  dispensary  system  of  New  York,  transmitted  to  the  Legislature,  Juue  14, 
1876.    Albany,  187G. 

t  Italics,  mine.  t  Italics  mine. 


25 

sonal  character  and  fitness  for  their  respective  duties.  The 
members  of  the  medical  staff,  excepting  the  house  and  visiting 
physicians,  receive  no  pecuniary  remuneration."*  Let  that  be 
noted  I  say,  for  a  contrary  opinion  is  oftentimes  encountered 
by  the  unpaid  medical  and  surgical  staff  of  every  dispensary 
and  every  institution  of  a  similar  character  in  this  city — 
"and  the  salary  of  the  visiting  physicians,"  i.  e.,  those  who 
go  from  house  to  house,  "  are  usually  very  meagre."  To 
which  I  may  add  that  the  salaries  of  the  house  physicians 
and  surgeons  do  not  correspond  with  the  labor  and  skill  with 
which  those  offices  are  usually  filled.  "Diseases  of  every 
variety  are  treated."  "  Free  vaccination  is  offered  to  all." 
"Dentistry  in  the  most  important  of  its  varied  branches,  under 
the  direction  of  competent  men,  has  also  its  value  in  connec- 
tion with  the  administration  of  dispensary  charity."  "  The 
doors  are  closed  to  none,  of  whatever  nationality,  creed  or 
color;  all  receive  alike,"  [and  in  the  order  of  application, 
first  come,  first  served,  whether  white  or  black,  brown  or 
yellow,  j]  "all  receive  alike  the  same  care  and  attention."!  The 
subjects  of  Queen  Victoria,  from  her  American  dominions, 
are  treated  with  courtesy  as  human  beings  needing  help. 

The  natives  of  Alaska  and  of  Iceland,  and  the  inhabitants 
of  Cuba  are  not  neglected  when  they  apply  for  aid.  Even 
the  red  man,  the  Sandwich  Islander,  and  the  heathen  Chinee 
receive  their  due  share  of  attention.  Dispensaries  are  cos- 
mopolitan. "  Those  whose  illness  will  not  allow  them  to  attend 
at  the  dispensary,  are  attended  in  their  homes  by  the  visiting 
physician,  and  the  medicines  prescribed  (by  him),  are  fur- 
nished at  the  dispensary,"§  free  of  charge,  on  presentation  of 
the  written  prescription  presented  by  the  messenger  sent  by 
the  patient  or  his    friends.)     I    have    ventured  to    add    this 

*  Italics,  mine.  t  Ludlum.  t  Ludlurn. 

§  Roosevelt,  super,  p.  5. 


26 

latter -clause  to  .Mr.  Roosevelt's  very  complimentary  notice, 
and  I  will  venture  -till  further  to  make  myself  the  self-elected 
mouth-piece  of  all  others  engaged  in  this  kind  of  Bervice  like 
myself,  and  say  that  we  heartily  thank  him  tor  his  careful 
observation  and  kind  words.  From  henceforth  the  ancient 
reproach, 'he's  nothing  but  a  dispensary  physician,' has  lost 
its  sting.  BVom  henceforth,  the  dispensary  physician  may 
proudly  hold  up  his  head  and  say,  as  did  the  colored  man 
down  South,  "I  am  no  shoe-string  nigger,  hut  1  am  a  gentle- 
man." 

But  His  Honor  Judge  Daly,  and  General  Mather,  and 
Commissioner  Roosevelt,  all  three,  are  silent  on  one  very  im- 
portant point,  which  they  naturally  could  not  appreciate  as 
well  as  the  men  actually  engaged  in  dispensary  service,  viz.  : 
the  efficiency  of  dispensaries  as  training  schools  for  the 
younger  members  of  the  profession,  and  as  schools  of  instruc- 
tion for  students  of  every  grade.  This  is  a  subject  completely 
out  of  the  range  of  thought  of  even  such  distinguished  laymen. 
But  we  who  have  been  for  any  length  of  time  engaged  in  dis- 
pensary service  are  tally  conscious  of  the  facts  in  the  case.  We 
learn  our  proper  business  there,  just  like  a  clerk  does  in  a 
banking  house  where  large  and  varied  accounts  are  kept. 
Dispensaries  are  not  places  for  mere  experimentation  by  a 
fresh  hand,  for  there  is  an  established  routine,  and  every  new 
man  when  he  comes  into  the  ranks  must  either  stand  in  the 
line  or  fall  out.  But  I  need  not  enlarge  on  this  point,  I 
think  that  this  plain  statement  will  suffice.  But  there  are 
defects  in  the  dispensary  system,  I  think  1  hear  some  one  say. 
Very  well.  But  can  you  point  out  any  human  institution 
which  is  devoid  of  defects,  or  into  which  aberrations  may 
not  intrude?  Yes,  there  is  at  least  one  medical  institution  in 
the  United  States  so  happily  arranged  as  to  be  perfectly  satis- 
factory to  all  parties  concerned — and  that  institution  is  in  the 


27 

city  of  Philadelphia,  which  city  seems  to  be  coming  in  for  all 
the  honors  just  now — and  if  the  expression  of  satisfaction  by 
Dr.  A.  D.  Hall  on  the  completion  of  the  improvements  recently 
made  in  the  "Wills  Ophthalmic  Hospital"  in  the  city  of  Phila- 
delphia is  not  exaggerated  compliment  to  those  who  furnished 
the  means  for  the  improvements,  it  must  be  just  about  perfect. 
"As  spokesman  of  my  fellows,"  says  Dr.  Hall  to  the  President 
and  gentlemen  of  the  committee  on  Wills  Hospital,  "  as 
spokesman  of  my  fellows,  the  surgeons  of  this  house,  I  thank 
you  for  the  beautiful  and  convenient  wards  you  have  just  en- 
trusted to  our  professional  care.  For  the  first  time  in  forty- 
three  years,  we  have  wards  built  for  the  express  purpose  of 
treating  the  diseases  and  injuries  of  the  eye,  with  all  the  im- 
provements in  ventilation  and  heating,  bathing  and  drainage, 
that  the  latest  science  and  experience  can  suggest.  It  is  no 
exaggeration  when  I  say  that  no  eye  hospital,  in  all  the 
round  world,  has  wards  so  well  adapted  to  the  business  to  be 
carried  on  within  them."* 

There  is  then  at  least  one  "  satisfied  soul  "  among  the  doc- 
tors, and  Philadelphia  has  at  last  excelled  New  York  city  in 
one  respect,  viz.,  as  to  Ophthalmic  hospitals,  and  what  is  more, 
the}7  have  struck  out  there  an  improvement  in  the  dispensary 
system,  which  improvement  has  been  practically  tested,  as  ap- 
pears from  the  following  extract  from  the  medical  report  of 
the  eye  and  ear  department  of  the  Philadelphia  dispensary, 
for  the  year  1875.  "  The  evening  service  (from  6  to  7  in  the 
evening),  has  been  found  a  most  valuable  adjunct  in  provid- 
ing for  the  laboring  classes  engaged  during  the  day,  and 
who  otherwise  would  have  been  compelled  to  forego  all 
treatment."  Well,  let  Philadelphia  have  all  her  honors  for 
the  time  being.  But  New  Yorkers  wake  up.  Philadelphia 
has  caught  you  asleep  this  time  in  the  matter  of  elymosynary 

"Wills  Ophthalmic  Hospital  Rep.  for  1875,  p.  14. 


28 

institutions,  for  the  relief  of  diseases  of  very  important  organs 
in  a  commercial  sense  We  want  neither  blind  nor  deaf  clerks 
and  paupers.  We  need  to  keep  our  city  clear  of  them,  as  well 
as  free  from  pestilence  in  another  form,     hi  conclusion,  it   is 

eminently  gratifying  to  find  three  laymen  in  our  midst  who 
have  written  concerning  this  subjecl  with  such  evident  relish 
and  acumen.  The  work  we  have  done  is  appreciated  by 
some  beyond  all  question.  But  some  one  says  that  the  rate 
of  progress  is  not  rapid  enough  for  them.  Well  that  is  the 
case  with  everything  good.  "  Nihil  per  saltern,"  is  nature's 
law.  You  can  not  get  up  "rapid  transit"1  on  that  line.  You 
may  salt  the  track  as  much  as  you  please  to  get  rid  of  the  icy 
obstructions,  but  the  "  nihil  per  saltern"  still  remains.  This 
fact  has  been  more  elegantly  expressed  by  the  poet,  who  says 

*"  The  mills  of  God  grind  slowly, 
But  they  grind  exceeding  fine." 

There  is  more  truth  than  poetry  in  these  lines,  and  it  he- 
hooves  us  to  remember  the  sentiment.  That  is  indubitably 
true,  and  what  is  true  is  good. 

A  few  words  more,  and  then  1  submit  the  matter  to  you. 

The  visiting  physicians  of  the  various  dispensaries,  who  go 
about  from  house  to  house,  wherever  called,  among  the  poor, 
go  about  the  city  in  ordinary  citizens'  dress,  and  their  dress  is 
oftentimes  of  the  least  expensive  character — sometimes  from 
choice,  sometimes  from  necessity;  and  but  few  persons  realize 
how  important  their  mission  is.  The  citizens  of  this  and  other 
cities  maintain  police  and  lire  departments  for  the  safety  of 
their  valuables  and  houses  and  tenements.  They  maintain 
these  departments  well,  and  the  well-dressed  members  of  these 
departments,  in  addition  to  the  work  they  do,  make  <piite  a 
show  on  the  streets.     But  the  visiting  physicians  of  the  vari- 

*  TeunyeoD,  with  amendment?. 


29 

ous  dispensaries,  silently  and  unobservantly  for  the  most  part, 
guard  you  from  enemies  more  insidious  and  deadly  than  either 
fire  or  thieves.  They  guard  you  citizens  of  New  York  against 
loss  of  those  whom  you  hold  dearer  than  your  stocks  and  jew- 
els, bonds,  houses  and  tenements.  They  do  their  work,  more- 
over, at  a  most  ridiculously  small  expense  to  you,  and  you 
citizens  allow  the  managers  and  trustees  of  dispensaries  to  go 
about,  always  begging  for  the  wherewithal  to  carry  on  the 
work  of  dispensaries  in  all  their  departments,  and  when  still 
harder  times  come  to  these  underpaid  public  benefactors,  you 
force  the  managers  and  trustees  of  dispensaries  to  cut  down 
the  salaries  to  a  disgustingly  mean  figure.  Now,  if  you  want 
to  see  an  old  servant  in  the  dispensary  service,  and  at  the 
same  time  to  see  a  specimen  of  old  New  York,  go  and  look  at 
the  Northern  Dispensary.  It  reminds  me  of  a  sentry-box. 
It  is  just  about  the  dimensions  of  a  good  sized  guard  house, 
in  which  its  sanitary  sentinels  may  assemble  prior  to  going 
out  on  their  rounds.  If  you  go  into  the  building,  after  taking 
a  good  look  at  the  outside,  you  will  find  there  a  sanitary 
officer  who  can  give  you  over  twenty-eight  years  history  of 
the  place,  and  show  you  all  its  reports,  and  you  can  reckon 
up  all  the  work  it  has  done  and  count  the  cost.  But  I  warn 
you  not  to  occupy  too  much  time  at  any  one  visit  in  such 
investigations,  so  as  to  interfere  with  the  business  of  the  place. 
The  other  dispensaries  of  the  city  have  been  considerably 
altered  and  changed  in  appearance  with  the  lapse  of  years, 
but  the  Old  Northern  Dispensary  will  always  continue  not 
much  larger  than  a  good  sized  sentry  box,  as  long  as  it  stands 
on  its  present  site,  but  if  it  is  not  much  larger  than  a  good 
sized  sentry  box  it  is  a  very  effectual  sentry  box  in  the  matter 
of  guarding  against  the  incursions  of  pestilence  and  death, 
and  the  diseases  which  may  attack  the  rich  through  their  neglect 
of  the  sanitary  condition  of  .the  poor.     Citizens,  as  you  value 


30 

ymir  household  treasures,  take  good  care  <>f  the  outposts  and 
bulwarks,  and  then  your  habitations  will  be  more  safe  than 
they  can  be  otherwise.  'Take  very  good  care  of  these  sanitary 
outposts  and  bulwarks  and  then  your  domiciles  will  probably 
be,  so  far  forth,  the  abodes  of  cheerfulness  and  health. 


Date 

Due 

$ 

